tbuckley/cabot-search huggingface dataset:
Abstract 15551: Pulmonary Hypertension in Patients With Noonan Syndrome Undergoing Cardiac Catheterization
Authors: Shane Collins, Paul Critser, Kimberlee Gauvreau, Amy E Roberts, Mary P Mullen
Journal: Circulation (2022)

Introduction: Noonan syndrome (NS) is an autosomal dominant genetic disorder associated with a high incidence of cardiovascular disease. We sought to investigate pulmonary hypertension (PH) in patients with NS, as well as characterize the hemodynamics, cardiovascular interventions, genetics, and transplant-free survival. Methods: A retrospective, descriptive cohort study was conducted among patients with NS who underwent cardiac catheterization at Boston Children’s Hospital between 2000 and 2020. Patient demographic, clinical, and hemodynamic data were collected for cohorts of patients with and without PH. Results: Eight-seven patients with Noonan syndrome underwent cardiac catheterization in the study period. Fifty-nine (68%) patients had a NS-associated pathogenic variant, while 28 (32%) had a clinical diagnosis of NS. Eleven (13%) patients had PH by 6 th World Symposium on Pulmonary Hypertension criteria: two patients with Group 1 Pulmonary Arterial Hypertension (PAH), seven Group 2 PH, and two Group 4 PH. There were significant differences in NS-associated causative gene in patients with and without PH, with RAF1 (p=0.013) and KRAS1 (p=0.015) more common among PH patients. A clinical diagnosis of hypertrophic cardiomyopathy (p=0.009) was more common in PH patients, while valvar, subvalvar, or supravalvar pulmonary stenosis (p=0.011) was less common. PH patients were significantly more likely to have aortic-valve interventions (p=0.025) and less likely to have valvar right-sided heart interventions (p=0.037). Transplant-free survival at five years was lower in the PH group (73%) compared to the non-PH group (99%). Conclusion: In a cohort of patients with Noonan syndrome undergoing cardiac catheterization, we noted differences among those with and without PH for NS-associated causative gene, associated hypertrophic cardiomyopathy or structural heart disease, interventions, and transplant-free survival. The prevalence of PH among this population demonstrates the need for future studies on the association between NS and pulmonary vascular disease.
Abstract 15587: Combined Spontaneous Coronary Artery Dissection and Takotsubo Cardiomyopathy in a Patient With Chest Pain
Authors: Mohammad Fahad Salam, Abdullah Al-abcha, Yasser Radwan, Adolfo Martinez Salazar, Zulfiqar Qutrio Baloch, Matthew Wilcox
Journal: Circulation (2022)

Introduction: Spontaneous coronary artery dissection (SCAD) and Takotsubo cardiomyopathy (TCM) are uncommon non-atherosclerotic causes of acute myocardial infarction (MI). These patients have fewer cardiovascular risk factors than those who have atherosclerotic MI. Clinical presentation in both subsets of MI is identical due to which diagnosis requires echocardiography and coronary angiography. The incidence of TCM and SCAD in the same patient is scarce and only documented in a few case reports and a case series. Case presentation: We present the case of a 50-year-old female with a past medical history of hypertension, hypothyroidism, and median arcuate ligament syndrome. She presented to the emergency department with intermittent chest pain radiating to her upper back, both arms, and her left jaw and it was associated with nausea. On examination, she was tachycardic, tachypneic, and anxious. She had normal heart sounds with no chest tenderness. Her EKG demonstrated ST-elevations in leads II, III, aVF, V4, V5, and V6. Laboratory results showed elevated high sensitivity troponin of 11,949 (pg/ml) and 30,256 (pg/ml) four hours later. The patient underwent emergent coronary angiography, which revealed diffuse tubular stenosis suggestive of type 2 SCAD in the second obtuse marginal artery but otherwise normal coronary anatomy with minimal stenosis. Left ventriculogram showed antero-apical, apical, and infero-apical hypokinesis and basal hyperkinesis, suggestive of Takotsubo cardiomyopathy. Transthoracic echocardiogram (TTE) completed 48 hours later demonstrated improved contractility with lateral wall hypokinesis. The patient was managed conservatively with medical management, and she was discharged on aspirin, plavix, carvedilol, isosorbide mononitrate, and losartan. Conclusions: SCAD and TCM are uncommon diagnoses that can rarely co-exist. TTE can help diagnose TCM in patients with chest pain and elevated cardiac biomarkers. Non-occlusive coronary vasculature is a diagnostic criterion per the proposed Mayo Clinic criteria. This case highlights the importance of coronary angiography in patients with TCM for assessment of potential co-existent coronary vascular pathology; SCAD in our case.
Abstract 15601: Optimal Virtual Monoenergetic Settings for Spectral Ct With a Dual-Layer Detector: A Breakthrough in Evaluating the Patency of the Coronary Arterial Lumen With a Metallic Stent in a Real-World Study
Authors: Nobusada Funabashi, Kazuo Misumi
Journal: Circulation (2022)

Introduction: Evaluation of the patency of a metallic stent in coronary arteries using CT is difficult because the metallic stent causes a blooming artifact. The CT values of metallic stents are influenced by tube kilovoltage (kV). Recent spectral CT with a dual-layer detector can generate CT images at any kiloelectron voltage (keV) (range: 40-200) after ordinary acquisition using virtual monoenergetic settings (VMS). Hypothesis: Using a new spectral CT, we can determine the optimal VMS for evaluating the patency of stents in coronary arteries. Methods: We performed enhanced 128 slice Spectral CT 7500 scans with a dual-layer detector in 35 patients with CAC who underwent implantation of a metallic stent in coronary arteries (tube voltage: 120 kV). After scanning, VMS images at various keV values were created from the spectral-based images. We measured the mean CT values of the metallic stent, coronary artery calcification (CAC), lumen in the left coronary artery (LCA), and fat tissue around the coronary arteries in the axial images at each keV in the early phase with contrast. Results: Lower keV values were associated with markedly increased mean CT values of the metallic stent and CAC. The CT values of the lumen in the LCA were moderately increased. Conversely, the CT values of fat tissue were slightly decreased. The greatest differences in mean CT values between the metallic stent and lumen in the LCA were observed at 40-50 keV, however, those between the metallic stent and CAC were observed at 110-180 keV. The optimal keV for achieving the best contrast between the CT values of the metallic stent, CAC, and the lumen in the LMA at each patient was influenced by age, male sex. Conclusions: The metallic stent, CAC, lumen of the LCA, and fat tissue exhibit unique characteristics. When conventional rather than spectral CT is used to evaluate the patency of a metallic stent in coronary arteries, it is necessary to determine the optimal tube voltage based on the age and male sex of the patient.
Abstract 15320: The Effects of Hydroxychloroquine on Electrocardiogram Intervals
Authors: Ahlam Alawadhi, Moutaz El Kadri, Omar A Al Falasi, Rizwan Ahmed, Zainab Altaha, Amany Hillis, Basheer Panikkaveetil, Sara Abdalla, Honey Ansel Benette, Adhba Almubarak, Mohammed Saifuddin, Yousef Alattar, Abderrahim Oulhaj, Salem AlKaabi
Journal: Circulation (2022)

Background: Hydroxychloroquine (HCQ) was widely used as a potential therapy for COVID-19 infection. We studied the effects of HCQ on electrocardiogram (ECG) intervals. Methods: We conducted a large-scale retrospective study of COVID-19 patients treated with HCQ admitted between March 1, 2020 and June 1, 2020. Extensive medical chart review was performed. Baseline and on treatment ECG intervals were manually measured by 3 electrophysiologists. The QT interval was corrected using Bazett formula (QTc). The paired t-test was used for the main analysis. Results: Paired ECG data from 1890 patients were analyzed. The mean age was 47.0 (±12.6) years with a strong male prevalence (85.6%). The commonest comorbidities were hypertension (39.6%) and diabetes mellitus (36.8%). The average duration of HCQ therapy was 6.3 (±2.3) days. 404 patients (21.4%) had severe COVID-19 infection and the mortality rate was 3.86%. Intensive care admission and mechanical ventilation was required in 209 (11.1%) and 166 (8.8%) patients, respectively. During therapy, heart rate (HR) decreased from 87.2 ± 16.8 bpm to 80.6 ± 14.7 bpm ( P &lt;0.001). The mean PR interval increased from 153.2 ± 21.9 ms to 162.9 ± 22.8 ms ( P &lt;0.001). The mean QRS duration increased from 92.8 ± 12.6 ms to 97.4 ± 13 ms ( P &lt;0.001). The average QTc increased from 427.4 ± 25.4 ms to 438.4 ± 29.9 ms ( P &lt;0.001). Conclusions: HCQ caused a modest but statistically significant prolongation in PR, QRS and QTc intervals. A reduction in HR was also noted mainly due to clinical improvement.
Abstract 15917: Burden of End Organ Damage Among Patients With Hypertension and Associated Patient- and Facility-Level Factors in Ghana
Authors: Samuel Byiringiro, Thomas Hinneh, FRED S SARFO, Yvonne Commodore-Mensah, Cheryl R Dennison Himmelfarb
Journal: Circulation (2022)

End-organ damage (EOD) are a serious complication of uncontrolled hypertension stroke, kidney disease, retinopathy, cardiovascular disease, and neuropathy are the most prevalent. The studies of EOD and associated factors are scarce in Sub-Saharan Africa. We explored the burden of EOD and the associated patient- and facility-level factors among patients with hypertension in Ghana. Methods: We recruited 14 health facilities and 15 patients with hypertension from each facility. Health facilities with hypertension services and patients on hypertension treatment were eligible for inclusion. The outcome of interest was the self-report of one or more of the most prevalent EOD. The patient-level independent variables were adherence to hypertension treatment, alcohol consumption, employment, and education. At the facility level, we included the facility type, size, ownership, and availability of hypertension guidelines as independent variables. The mixed-effect logistic regression model was used. Results: The study included two hundred and nine (209) patients. 172 (82%) were female, and the mean (±SD) age of participants was 61 (±12.7). 80 (38%) participants reported having suffered at least one EOD, the most prevalent being retinopathy, 38 (18%), followed by cardiovascular complications, 24 (11%). Employment was associated with lower odds (Odds Ratio: 0.42, 95% CI: 0.19, 0.90) of EOD than unemployment and tertiary or higher education was associated with lower odds (Odds Ratio: 0.32, 95% CI: 0.14, 0.74) of EOD than primary or lower educational level. Higher adherence to hypertension treatment was associated with lower odds (Odds Ratio: 0.88, 95% CI: 0.79, 0.97) of EOD. Conclusion: The prevalence of EOD is high. Patient-level interventions to improve hypertension care are needed with a focus on socio-determinants of health. Largescale studies are recommended to explore the facility-level factors that impact the development of EOD in Ghana.
Abstract 15802: Chemogenetic Activation of Intracardiac Cholinergic Ganglia Neurons Reduces the Incidence of Arrhythmias After an Acute Myocardial Infarction
Authors: Bridget R Alber, Jhansi R Dyavanapalli, Aman Gill, David Mendelowitz, Matthew W Kay
Journal: Circulation (2022)

Intracardiac cholinergic ganglia (ICG) neurons receive excitatory input from vagal pre-ganglionic fibers and are critical for the transmission of parasympathetic drive throughout the heart. During disease, electronic vagal stimulation improves cardiac function and reduces arrhythmias. However, vagal stimulation is not selective for efferent or cholinergic fibers and implanting an electronic device before unanticipated episodes of cardiac infarction is not clinically feasible. We addressed these limitations by testing the hypothesis that chemogenetic ICG activation immediately after an infarction would reduce arrhythmia incidence and improve ventricular function. Floxed DREADDs (AAV2-hSyn-DIOhM3D(Gq)-mcherry) were injected into the pericardial sac of neonatal rats that selectively express Cre recombinase in cholinergic neurons. At 8 weeks, hearts were excised for ex-vivo studies and excitatory hM3Dq DREADDs expressed in ICG cholinergic neurons were activated by clozapine-N-oxide (CNO). Heart rate (HR), LV developed pressure, and overall arrhythmia incidence were measured. In healthy hearts, CNO decreased HR for the duration of the experiment (247 ±10.56 to 189.35± 3.46 beats per minute, p&lt;0.0001, n=5). To study ICG activation after infarction, hearts received CNO or saline after complete ligation of the left anterior descending coronary artery or partial obstruction of the left coronary artery. The ECG was analyzed to assess PR interval and arrhythmia incidence, including non-sustained and sustained VT and fibrillation. ICG activation increased PR interval from 39.13 ± 2.75 to 42.46 ± 3.07 ms (p=0.0097, n=5). ICG activation also reduced arrhythmia incidence after coronary artery ligation from 1.65 to 0.6467 arrhythmias per min (p=0.042, n=5), an outcome that is likely motivated by ICG neuron inhibition of adrenergic activity in addition to vasodilation and increased coronary flow. These studies demonstrate that cardiac cholinergic ICG activation following an MI quickly elevates cardiac parasympathetic drive, protecting against arrhythmias. Future studies will focus on measuring the inhibition of adrenergic activity by chemogenetic activation of cholinergic ICG neurons and local coronary flow increases.
Abstract 15368: Outcomes of Anticoagulation in Patients With Transthyretin Cardiac Amyloidosis
Authors: Clint Kolseth, Mark Prasad, Pranav Chandrashekar, Morris Kim, Lana Rashdan, Yunwoo Burton, Ahmad Masri
Journal: Circulation (2022)

Introduction: Up to 70% of patients with transthyretin amyloid cardiomyopathy (ATTR-CM) have (AF) and require anticoagulation (AC). ATTR-CM is also associated with a higher bleeding risk due to advanced age, frailty, and comorbidities. Prior studies have shown that thrombi can be seen in any chamber of the heart. In the era of left atrial appendage occlusion (LAAO) devices, a reappraisal of AC outcomes in ATTR-CM is needed. Hypothesis: AC in patients with ATTR-CM is not associated with significantly different rate of bleeding as compared to patients who are not on AC. Methods: This observational study was performed on a single center of ATTR-CM patients (n=149) diagnosed between 2005-2022. Bleeding outcomes were stratified according to AF and AC status. The primary outcome was defined as a composite of all major bleeding. Bleeding episodes were further categorized into correctable or uncorrectable. HASBLED scores for each patient were also calculated. Results: Of the 149 patients reviewed, 94 (63%) had AF and 95 (64%) were on AC. In the overall population, 20 patients (13%) experienced a bleeding episode, with 30% (6 /20) of the episodes classified as uncorrectable requiring indefinite AC cessation. During a medium (IQR) of 3.1 (2.6,4.9) years of follow-up, there was no significant difference in bleeding between those who were on AC compared to those who were not on AC (P = 0.105). There was also no significant difference in bleeding between those who had atrial fibrillation and those who did not (P = 0.464). Patients who experienced a bleeding episode had a significantly higher average HASBLED score compared to those who did not experience a bleed (2.7 vs 1.7, P&lt;0.01) In total, 5 (5%) of ATTR-CM patients with AF would have been candidates for LAAO devices. Conclusions: AC is not associated with significantly increased risk of bleeding in patients with ATTR-CM compared to those who were not on AC. HASBLED scores may be useful in ATTR-CM. While further studies are needed to study the outcomes of LAAO devices in ATTR-CM, the incidence of requiring such an intervention in ATTR-CM appears to be low.
Abstract 15893: Etiologies for Hospitalizations and in Hospital Mortality in Patients With Atrial Fibrillation: Insight From National Inpatient Sample Database
Authors: Mahir Yilmaz, Hasan Hammo, Muhammad Khawar Sana, Sean DeAngelo, Bharosa Sharma, Muhammad Usman, Muhammad Usman Almani, IRIAGBONSE ASEMOTA
Journal: Circulation (2022)

Introduction: Atrial fibrillation is a common clinical syndrome that leads to high volumes of hospitalizations and in hospital mortality. Previous studies have attempted to characterize the various reasons for the high rates of morbidity and mortality associated with atrial fibrillation. Our study aimed to utilize large database information to identify the most common indicators for and cause of death in patients with atrial fibrillation. Methods: Using the National Inpatient Sample database, we analyzed atrial fibrillation hospitalizations during the years 2016-2019 and categorized reasons for hospitalization and in-patient mortality using the International Classification of Diseases, Tenth Revision, Clinical Modification (ICD-10). Results: We identified a total of 18,084,144 hospitalizations with atrial fibrillation as the principle or secondary diagnosis ICD-10 code. The most common systems involved were cardiovascular (37%), respiratory (10%), and infectious (10%). Specifically, the leading cause for hospitalization was heart failure (10%) followed by atrial fibrillation (9%) and sepsis (7%), There was a total of 848,579 cases of in-hospital mortality in patients with atrial fibrillation during this period. The most common reason for mortality was sepsis (26%), followed by acute respiratory failure (5%), heart failure (5%), non ST elevation myocardial infarction (NSTEMI) (2%), and pneumonia (1%). Conclusion: This study represents the most recent nationwide data on causes for hospitalization and mortality in patients with atrial fibrillation across the United States. In our analysis, we found that the most common cause of hospitalization was attributed to cardiovascular disease, specifically heart failure, while sepsis was the most common cause of inpatient mortality. A better understanding of why patients are hospitalized may lead to changes in practice to prevent admissions as well as in-hospital management to ultimately prevent death.
Abstract 15537: Complex Congenital Heart Patients: Education Program for Advanced Practice Providers
Authors: christine D meliones, Raven Z Houston, Sheikh S Ahmed, mohammed T Numan, Jorge D Salazar, Jon N Meliones, Antonio F Corno
Journal: Circulation (2022)

Introduction: With appropriate training and support, Advanced Practice Providers (APPs) offer value in specialty patient care in a congenital heart program (CHP) providing continuity, cost effective, and specialized care. Hypothesis: We hypothesized that APPs caring for patients in a CHP lack standard curriculum to quantify success and improvement. Developing a dedicated education program allows identification of knowledge gaps and improves focused learning. Integrating a shared model for education with pre/post-tests increases proficiency and professional development. Methods: 20 APPs were included in our CHP education model including 63 focused learning modules in pediatric cardiology with complex congenital heart disease (CHD) and cardiac intensive care with aspects of post-operative management, multi-disciplinary, APP-specific teaching sessions, APP-led journal clubs, research/QI projects, interactive lectures, visuals, and key articles. Knowledge of the core CHP learning objectives were measured through 514 individual pre/post module tests by utilizing and strategically combining peer reviewed resources in CHD/critical care for each learning module. APPs satisfaction was evaluated using a 5-point scale (outstanding, good, acceptable, fair, unsatisfactory) for core education, faculty support, and translation to clinical practice. Results: Increase in knowledge was observed with pre/post test scores of 67.2% and 97.6%, respectively (P&lt;0.0001). Fetal, chest radiography, and cardiac output were identified with lower pre-test scores &lt; 50% allowing refocused education, resulting in post-test scores &gt; 96% (P&lt;0.0001). Core education program, faculty support, and translation to clinical practice were scored as outstanding (n=10, 50%) or good (n=10, 50%). Conclusions: In conclusion, our APPs and multi-disciplinary specialists have successfully integrated an education program, improving performance in a rapidly growing department. The success in identifying educational opportunities via pretests and adapting our educational focus has provided an infrastructure to improve patient care and safety. Our efforts and bidirectional feedback have resulted in satisfaction and ideally long-term APPs retention.
Abstract 15433: Very Late Recurrence After Successful Ablation of Premature Ventricular Contractions in Patients Without Structural Heart Disease
Authors: Sanghamitra Mohanty, Sai Shishir Shetty, Domenico G Della Rocca, ANGEL QUINTERO MAYEDO, Bryan MacDonald, carola gianni, Karim Baho, Trevor Morris, Mohanad Elchouemi, Rami Helmy, Issa Asfour, G Gallinghouse, John Burkhardt, Rodney Horton, Amin Al-Ahmad, Andrea Natale
Journal: Circulation (2022)

Background: Earlier studies have shown the superiority of catheter ablation over pharmacological therapy in eliminating premature ventricular contractions (PVC) in patients without structural heart disease. We investigated very late recurrences after successful PVC ablation in this cohort. Methods: Consecutive patients undergoing clinically indicated radiofrequency ablation for symptomatic idiopathic PVCs, documented by standard ECG, were included in the analysis and prospectively followed up. Those with history of structural heart disease were excluded. For all patients, 12-lead ECGs were reviewed to assess PVC morphology. During the index procedure, all PVC morphologies were targeted for ablation. Standardized RF power settings (40-50 W) were used during the procedure. Ablation was performed using 4-mm irrigated tip catheter guided by 3-D mapping system and intra-cardiac echocardiography. Patients were followed up with remote monitoring as well as ICD interrogations and office visits every 6 months for 4 years. Long-term success was defined as absence of previously targeted PVCs or any new PVC morphology on 12-lead ECG or device interrogation during all follow-up visits. Results: In total, 638 patients were included (mean age 59.2±5.6 years, 69.75% male, LVEF 54±12%). At the index ablation, PVCs were detected to be localized in the right ventricular outflow tract in 268 (42%), left ventricular outflow tract in 299 (46.8%) and multiple sites of origin in 71 (11.2%) patients. Non-inducibility was achieved in all patients at the end of the index procedure. At 4 years, 585 (91.7%) patients remained arrhythmia-free. Remaining 53 patients (8.1%) experiencing recurrence underwent repeat procedure. Median time to recurrence was 29±6.2 months. At the redo, new PVC morphologies were detected and ablated in 46/53 (86.8%) patients. One year after the repeat ablation, 50/53 (94.3%) were arrhythmia-free. Conclusion: In this prospective single-center series, very late recurrence following index PVC ablation in patients with no structural heart disease was mostly associated with new PVC morphologies that were amenable to be successfully ablated at the repeat procedure.